Short-term inpatient psychiatric stays increased for youth but declined for older adults between 1996 and 2007, according to an analysis published online ahead of print August 1, 2011, in the Archives of General Psychiatry.

Background

Joseph C. Blader Ph.D., of Stony Brook University, evaluated data from 1996-2007 from the National Hospital Discharge Survey, an annual survey conducted by the National Center for Health Statistics. He aimed to determine the rates of short-term hospitalizations and length of stays among children, adolescents, adults, and older adults due to psychiatric diagnosis. This time period roughly corresponds to the decline in use of long-term inpatient services for psychiatric illnesses, decrease in number of psychiatric beds made available, and stricter criteria for insurance authorization of hospital admission.

Results of the Study

The data showed that hospitalization rates increased the most for children ages 5-12, going from 155 per 100,000 children in 1996 to 283 per 100,000 children in 2007. Among teens, the rate increased from 683 to 969 per 100,000. Among adults, the rate increased from 921 to 995 per 100,000. By contrast, the rate declined among the elderly, going from 977 to 807 per 100,000.

Hospital stays were consistently shorter among children and teens, especially those with private insurance. The proportion of inpatient days paid by private insurers declined among children (going from 36 percent to 21 percent), adolescents (going from 52 percent to 22 percent) and adults (going from 35 percent to 23 percent.)

Significance

The trends likely reflect an increase in clinical need rather than an overuse of hospital resources, especially when taking into account the decline in number of psychiatric beds available, according to Blader. Admission information and diagnostic trends over the same time period indicate that the impairments and problems of hospitalized patients appear to have grown more acute. He also notes that the trend corresponds with an increase in bipolar diagnosis, especially among youth. Blader suggests that as long-term care facilities decreased their capacity, short-term facilities may have had to compensate for the shortage. Surveys among state mental health officials during the same time period indicate they were worried about a shortage of beds for acute care as well.

What’s Next

More research is needed to determine how these trends are affecting quality of care and insurance issues and reimbursement.

Citation

Blader JC. Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Archives of General Psychiatry. Online ahead of print Aug 1, 2011.